[Magdalen] Drug research.

[James Oppenheimer-Crawford]

Sorry, but if you don't mean board certified, then what would you mean?
I've worked with a lot of physicians who were not psychiatrists, yet made a
serious effort to know their stuff, and I think they did a pretty good job
overall.  We did get a few clinkers, of course, but that's par for the
course.

Sorry you were offended, since I agree with you.

James W. Oppenheimer-Crawford
*“A life is like a garden. Perfect moments can be had, but not preserved,
except in memory. LLAP**”  -- *Leonard Nimoy

On Sun, Aug 28, 2016 at 9:07 PM, Jay Weigel <jay.weigel at gmail.com> wrote:

> I did not say "board cerified psychiatrists". I said them *and* other
> doctors who had taken a course in psychopharmacology, passed an exam, and
> gooten a certification. Please do not misquote me.
>
> On Sunday, August 28, 2016, James Oppenheimer-Crawford <
> oppenheimerjw at gmail.com> wrote:
>
> > It's a dicey business.  On the one hand, you're absolutely right: only
> > board certified psychiatrists ought to be able to prescribe.  On the
> other
> > hand I can think of two serious considerations here:
> > First of all, many psychiatric facilities run by the states have a
> history
> > of employing MDs who are not board certified. It's not too extreme to say
> > that if only board certified MDs could prescribe, we would not be able to
> > hire the people at the price they are willing to pay. They simply
> wouldn't
> > be able to get the personnel.
> > And the other matter is the rapidly changing pharmacological picture.  I
> > recall when I first began to work back in 1975, there were not a lot of
> > meds available. But that quickly changed.  I had kept current on
> > medications' main purposes, side effects, general dose range, etc., but
> in
> > just a few years it became a hopeless case.  Every year brought some new
> > validated medication and new protocols. And also, the sudden terror of
> > retinitis pigmentosa from Mellaril and the general concern about tardive
> > dyskinesia suddenly changed utterly the way medication was prescribed.
> > Also, we would welcome a new antipsychotic with the hope that this one
> > might be that magic bullet. And it almost never happened that way.  I say
> > this to illustrate how a physician completely up to date and certified
> in,
> > say 1990, might quite easily be completely out of touch in just a few
> years
> > unless she or he conscientiously takes refresher courses.
> >
> > Rehabilitation was a known factor from years back (I still remember an
> old
> > film we watched, made in England in the 1950s, which introduced the
> basics
> > of what we ended up doing for years), and it gradually gained traction
> over
> > time in my facilities. By the time I retired about ten years ago, the
> > strategy had become medication to stabilize and then a lot of day
> programs
> > of various types, designed to build on each consumer's strengths.  We
> > talked about the illness, how the consumer had to understand the nature
> of
> > their illness and learn to avoid trigger situations, and move toward
> things
> > that helped. Meds were merely a very beginning step.
> > Early on, I was taught that we expect the psychiatric patient to require
> > constant medication to compensate for their chemical imbalance for the
> rest
> > of their lives.  As time went by, we found that was simply not true.  A
> > person can be acutely psychotic and then, after a robust rehabilitation
> > intervention, can learn to live a fairly normal life with reduced
> > medication. I had the pleasure of meeting and talking to some of these
> at a
> > psychiatric rehabilitation convention. I wanted to get these folks into
> my
> > facility; there's nothing so powerful as someone standing there talking
> to
> > a very ill consumer, saying, "I used to be right where you are now, and I
> > took my meds, talked with my doctor, and went to programs, and today I'm
> > working a fulltime job.  You can too."
> > I've seen some amazing accomplishments too -- folks I really never
> expected
> > to leave the facility did in fact get it together with the help of
> titrated
> > meds and the right programming.  We sometimes were able to do some very
> > good work.
> > By the time I retired, most physicians had bought pretty solidly into the
> > rehab model, although the drug companies kept up their promotions,
> claiming
> > that certain difficult psychiatric patients could be cured with the
> > particular pill they were selling that month.
> > I was hired into a hospital whose Director was a psychiatrist (one who
> was
> > deeply committed to psych rehab, but still a psychiatrist). After that,
> the
> > head was an administrator who had come up through some other career
> ladder.
> > We have all those pictures of those psychiatrists (male, of course) who
> > used to be the director. Now, the pictures are just as often female as
> > male, and we have not had a physician director after the one previously
> > mentioned.
> > When I was hired in one facility, the sister facility across the county
> was
> > still directed by the old style director, and nurses generally wore their
> > whites. I only saw a nurse in whites in the medical clinic. I can imagine
> > that if I were to go to another state, things may well be very different.
> > Sometimes, folks would say that New York State was the best of the
> best.  I
> > had to wonder, if we were "the best," then how was the rest of the world
> > doing? We certainly had our share of dropped balls...
> >
> > So meds still plays an important part, and always will, but it's also
> only
> > a piece of the puzzle. Each consumer is a separate puzzle, requiring her
> or
> > his own special interventions.
> >
> > James W. Oppenheimer-Crawford
> > *“A life is like a garden. Perfect moments can be had, but not preserved,
> > except in memory. LLAP**”  -- *Leonard Nimoy
> >
> > On Sun, Aug 28, 2016 at 11:01 AM, Jay Weigel <jay.weigel at gmail.com
> > <javascript:;>> wrote:
> >
> > > Here in the U.S., only M.D.s may prescribe psychoactive drugs.
> > > Unfortunately, Drug companies have put big bucks into advertising ("Ask
> > > your doctor if this medication is right for YOU!" blares the TV) and
> > this,
> > > plus loose regulations on which doctors may prescribe such, can lead to
> > > some awful messes. IMNSHO, no doctor should be allowed to prescribe
> such
> > > medications who has not taken an intensive course in
> psychopharmacology,
> > > passed an exam with a sufficiently high score and been certified.
> > > Furthermore, also IMNSHO, prescription drug advertising should be
> > outlawed.
> > > It is coercive and leads to patients who are poorly informed pestering
> > > their doctors for medications which may not be in their best interests
> > and
> > > are generally very high-priced.
> > >
> > > Stepping off my soapbox,
> > > Jay
> > >
> > > On Sun, Aug 28, 2016 at 12:54 AM, Sally Davies <sally.davies at gmail.com
> > <javascript:;>>
> > > wrote:
> > >
> > > > For me this is an interesting and helpful thread, aside from the
> > personal
> > > > rebukes.
> > > >
> > > > As a psychologist who does not prescibe but has to work with
> medicated
> > > > patients, I feel confused at the moment regarding best practice in
> > mental
> > > > health. There has been so much manipulation and outright corruption
> in
> > > > mental health, and the (thinking, reading) public is also confused
> > > > especially regarding children. Meanwhile MH problems in the elderly
> > often
> > > > go undiagnosed or treate.
> > > >
> > > > I seldom advise anyone to consult a psychiatrist any more but these
> > days
> > > > most of my patients are hospitalised in a general hospital, and the
> > > > physicians - you would call them internists - often prescribe
> calming,
> > > > sleeping and antidepressant medication.
> > >
> >
>